December 1996 XVIII/4
RELIGIOUS BELIEFS & LIFE SAVING THERAPY
Last month in the Saint Louis area, a 40 year old woman and her son died after the woman refused a blood transfusion. As a member of Jehovah's Witnesses, Bettye Joyce Beal believed that blood transfusions are prohibited by her religion. When she slipped and fell in her home, she was quickly losing blood. After entering a hospital, it was determined that the baby in her womb was not getting the blood and oxygen he needed. According to medical opinion offered in the press, both mother and child might have survived if blood were transfused at the proper time. The rights of Jehovah's Witnesses to refuse blood transfusions for themselves or for their children is often posed in ethics classes as a problem in applying the principle of informed consent. But this actual case provides some controversial aspects and an impetus to look more closely at the fundamental and related issues arising from the refusal to utilize a seemingly innocuous and successful life prolonging therapy.
Principles
One of the most controversial ethical issues in the relationship between medicine and religion occurs when a Jehovah's Witness refuses a blood transfusion, even though death may occur as a direct result of this refusal. Clearly, the belief results in a confrontation between the Hippocratic Oath and the individual's religious freedom. Usually the refusal of the person on religious grounds to receive a blood transfusion is honored. Both because it is a legal principle of American society that people have a right to refuse medical treatment and because the ethics of medicine requires that therapy always be offered in accord with the spiritual or religious values of the person in question. The belief that blood transfusions are contrary to biblical admonition is a belief not shared by other Christian communities. It is true that certain passages of the bible prohibit eating meat with blood still in it and drinking blood from animals offered in sacrifice to pagan gods. (1) But the prohibitions mentioned are considered by most biblical exegetes to be mere dietary laws no longer in effect, or at best, laws which are directed to prohibiting idolatry. More importantly, the passages which prohibit eating or drinking blood say nothing about blood transfusions. In an interesting article, (2) Richard Singelenberg reports that blood transfusions were not prohibited by the teaching authority of the Jehovah's Witnesses until 1945, well after the founding of this Church. At first, he maintains "the Society hardly paid any attention to the new ruling," and "until the mid-forties the issues received only marginal attention in the Society's publications." By the 1960's however, the admonition concerning blood transfusions had not only consequence in regard to personal conscience, but it was also stated that accepting transfusions of blood would be followed by "disfellowshipping'' (excommunication). He attributes this prohibition to social factors rather than the biblical interpretation. In sum, Singelenberg maintains that the prohibition of blood transfusions derives more from a desire to establish a practice that would separate Jehovah's Witnesses from the institutions of society (medicine being one of the prominent social institutions) than it does from a well-reasoned interpretation of the pertinent scriptural passages.
No matter what the history of the belief, it is clear that today refusing blood transfusions, or ingestion of plasma or any other blood product, is a religious norm for a Jehovah's Witness who is seriously committed to the teaching of their Church. Is this a form of suicide? No, the intention of a Jehovah's Witness is to follow his or her faith. The fact that the person may die as a result of this choice is an indirect result of the choice to follow the faith teaching. For this reason, when Bettye Joyce Beal stated that she did not wish to have a blood transfusion even though her death would result, her wishes were honored.
Discussion
The case is complicated immensely however, by reason of the fact that Mrs. Beal's decision also affected the baby boy, Aviz by name, to whom she was about to give birth. Had she been given a transfusion before birth, the baby's chances of survival after Caesarean section birth would have been better. But after the birth, Roger Beal, the father of the child, told medical staff that "his religion required that they not transfuse the child. That's what his mother would have wanted. I couldn't go against her." Should the wishes of Roger Beal have been honored, even if Aviz, whose chances of survival by this time were slim, would die as a result of a low blood supply?
When considering the relationship between parents and children from the ethical perspective two interrelated assumptions are paramount. First the family unit must be fostered and protected because it is the fundamental element on which society and culture depends for strength and continuity. Second, parents should have care and custody of their children because experience shows that parents love their children and strive to help them become virtuous human beings. Like most ethical assumptions, this latter one yields to contrary evidence. Hence, if parents are abusing their children and endangering their lives, then society intervenes and removes the children from the parents' custody, at least for a time. The right of intervention on behalf of children illustrates another ethical assumption; namely, that parents do not "own" their children. Rather, parents are stewards, caretakers of their children, enablers who help their children grow in knowledge and virtue. Above all, life and death decisions concerning children are not to be made for the parents' benefit.
Both ethical reasoning and legal precedent give priority to the expression of a person's religious faith. Because religious faith is the most personal, important, and profound act of conscience, its expression should be honored unless it is manifestly injurious to other people. Hence, as long as parents respect the well-being of their children, they have the ethical and legal right to rear and educate their children in the religion of the parents' choice. The right to choose a religion for children, as well as many other rights, gradually wanes as children mature and are able to make competent decisions for themselves. Here, or course, we encounter the crux of the matter: When are children able to make competent decisions for themselves? When do children become young adults? The laws of every country try to solve this question by stating that, for legal purposes, young people become adults at age 17, 18, or 21, depending on the right in question. (Strangely, in most states, young people may marry at an earlier age than they may buy alcoholic beverages.) The laws, however, express only a general norm; it may often happen that a young person is mature enough to make important decisions for himself or herself well before the legal age of maturity. In recognition of this fact, ethicists now suggest that teenage children be asked to give their "assent" to surgery or other serious medical treatments, even though the proxy consent of their parents or guardian will suffice for ethical and legal clearance for medical treatment. While it may be difficult to judge maturity of a teenager, there is no quandary when infants are concerned. Clearly, they are unable to make mature judgments, and decisions concerning their well-being are the responsibility of their parents. If parents fail in their responsibility, then the courts, acting in the name of society, are called upon to enter into the decision making process.
The habitual response of the court, the voice of society in regard to ethical behavior, is to grant permission for transfusions if the life of an infant is endangered. In fact, in emergencies, this permission may be made by a medical team, and reported later. The intent of the court is not to criticize the religious belief of the parents or the teaching of their church. Rather, the decision of the court is based on the fact that the children are not old enough to make a faith commitment of their own.
Conclusion
The baby, Aviz Beal, was given a transfusion but by the time he received it he was so compromised that he died shortly thereafter. Could the court have mandated that Mrs. Beal receive a transfusion before her death, when it might of done some good for the infant? Ethically speaking, it seems a good case could have been made for transfusing Bettye Beal so that Aviz could live. Though the abortion laws of our country are in opposition, it is the moral responsibility of a mother to care for the child which she carries in her womb. Practically speaking however, it would be difficult to enforce a court order mandating transfusions of a pregnant woman.
Kevin O'Rourke, OP
Footnotes 1. Genesis 9:3-4; Acts 15:19-21; cf. How Can Blood Save Your Life?, Watch Tower Bible and Tract Society of New York, Inc., 1990.
2. Richard Singelenberg, Social Science Medicine 4, (1990):515-523.
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